Holding physicians accountable for cost of care?

Holding physicians accountable for quality of care and outcomes is understandable. But, should we be held accountable for healthcare costs also?

Paul Keckley, PhD, managing director of the Navigant research center, which conducted a recent study with the American College of Physician Leadership states "Physicians want to be accountable for the elements of care that they can control,” Keckley says. “But what frustrates physicians is where they’re held accountable for things out of their control.” What he is saying is what we all know to be true.

If patient's do not lose weight, do not take their medications as instructed, eat what they want, do not exercise, continue to smoke, drink or use drugs, should their physicians be held accountable?

The survey reports that 69% of physician leaders say we should be held accountable for costs of care, in addition to the quality of care. Remember, that the survey respondents may not be front-line physicians, though. Nevertheless, some costs are directly related to the physician and his or her treatment plan.

Cutler and colleagues from Harvard report that "35 percent of end-of-life spending, and 12 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence." For history's sake remember that David Cutler is the Harvard health economist and advisor to President Obama's 2008 campaign, who wrote a memo in 2010 arguing that the White House had the wrong team in charge of health reform and advised them to completely overhaul their implementation strategy! They did conclude that financial considerations and malpractice fears played a very minor role and pressure to please patients and their families had modest influence on treatment plans.